COLORADO DIVISION OF SECURITIES 1580 Lincoln, Suite 420 Denver, CO 80203 FORM RC-C Registration by Coordination Closing Report Date: Colorado File No.: Name of Issuer: Address: City: S tate: Zip: 1. Total of issue offered in all states: A) Total number of securities: B) Total dollar amount of securities: $ 2. Total sales made in all states: A) Total number of securities: B) Total dollar amount of securities: $ 3. Total of issue registered in Colorado: A) Total number of securities: B) Total dollar amount of securities: $ 4. Total sales made in Colorado: A) Total number of securities: B) Total dollar amount of securities: $ By: Title: (Rev. 7/1/2004) American LegalNet, Inc. www.USCourtForms.com